Dokotala wanu akakuuzani kuti mwana wanu ayenera kuchitidwa opaleshoni ya Fontan chifukwa cha vuto la mtima wobadwa nalo, mungamve mantha komanso mantha ambiri. Mafunso ambiri angabwere mwadzidzidzi m'maganizo mwanu. Ndizachilendo kuganiza zinthu monga, "Ndi opaleshoni yanji imeneyo?", "N'chifukwa chiyani mwana wanga akukumana ndi izi?", "Kodi adzakhala bwino pambuyo pa izi?" Musadandaule. Tiyeni tikambirane za izi modekha komanso momveka bwino. M'nkhaniyi, ndiyesetsa kuyankha mafunso anu okhudza izi m'njira yosavuta.
Mwachidule, kodi njira ya Fontan ndi chiyani?
Kuti timvetse izi, choyamba tiyeni tikumbukire pang'ono za momwe mtima wathu umagwirira ntchito. Mtima wathanzi uli ndi zipinda zazikulu zinayi. Ziwiri pamwamba ndi ziwiri pansi. Timazitcha zipinda ziwiri zazikulu, zolimba pansi pa ma ventricles awa. Chipinda chimodzi chimasonkhanitsa magazi "odetsedwa" m'thupi omwe alibe mpweya wabwino ndipo chimapopera kupita ku mapapo kuti atenge mpweya wabwino. Chipinda china chimasonkhanitsa magazi "oyera" okhala ndi mpweya wabwino kuchokera m'mapapo ndikupopera kupita ku thupi lonse. Ziwirizi zimagwira ntchito ngati ma moteri awiri amadzi.
Komabe, ana ena akabadwa, limodzi mwa maselo awiriwa silikhala lokwanira kukula. Kenako, selo lokhalo labwino liyenera kuchita ntchito zonsezi. Ndiko kuti, liyenera kupopera magazi kupita ku mapapo ndi thupi lonse. Tangoganizirani kulemera kwa injiniyo ikayenera kupopera madzi kupita ku nyumba ziwiri ndi injini imodzi. Chifukwa chake, selo limodzi ili liyenera kugwira ntchito pansi pa katundu wolemera.
Izi ndi zomwe opaleshoni ya Fontan imachita : Madokotala opanga opaleshoni amapanga njira yachidule yopita kumtima. Izi zimathandiza kuti magazi opanda mpweya kuchokera m'thupi la pansi ayende mwachindunji kupita ku mapapo, kudutsa mtima. Kwenikweni imadutsa magalimoto ambiri a mtima.
Mwa kupanga njira yachidule ngati iyi, katundu pa selo limodzi lomwe linkagwira ntchito molimbika amachepa kwambiri. Kenako, selo limenelo lingagwiritse ntchito mphamvu zake zonse ndikupopera magazi oyera, okhala ndi mpweya wambiri m'thupi. Izi zimawonjezera kuchuluka kwa mpweya womwe thupi la mwana limalandira, ndipo amamva bwino.
Kodi opaleshoniyi imachitidwa pa ana amtundu wanji?
Opaleshoni ya Fontan si yochitidwa kamodzi kokha. Nthawi zambiri imachitika ngati gawo lachitatu komanso lomaliza pa opaleshoni zingapo za mwana yemwe ali ndi vuto la mtima la chipinda chimodzi. Opaleshoni imodzi kapena zingapo zisanachitike, zingafunike kutengera zaka ndi momwe mwanayo alili.
| Mitundu ya maopaleshoni am'mbuyomu | Mwachidule, chimachitika n’chiyani? |
|---|---|
| Njira ya Norwood | Mbali yakumanja ya mtima imathandiza kupopera magazi kupita ku thupi ndi m'mapapo. Izi nthawi zambiri zimachitika m'masabata oyamba mwana atabadwa. |
| Njira ya Glenn | Magazi omwe alibe mpweya wabwino m'thupi lapamwamba amatumizidwa mwachindunji ku mapapo. Nthawi zambiri iyi ndi gawo lachiwiri. |
| BTT shunt (Blalock-Taussig-Thomas shunt) | Chitoliro chopangidwa chimagwiritsidwa ntchito kuwonjezera kuchuluka kwa magazi omwe amapita ku mapapo. |
| Chingwe cha mtsempha wa m'mapapo | Imawongolera kuyenda kwa magazi kupita ku mapapo ndipo imalola magazi ambiri kupita ku ziwalo zina za thupi. |
Zinthu zazikulu zomwe zimafuna opaleshoni ya Fontan
Opaleshoni iyi imafunika makamaka nthawi zina pamene mtima sunapangidwe bwino pobadwa. Izi ndi izi:
- Matenda a mtima osagwira ntchito bwino: Ichi ndi chomwe chimayambitsa vuto lalikulu. Pa vutoli, mbali yakumanzere ya mtima siimakula bwino.
- Matenda a mtima ochepetsa mphamvu ya mtima: Pa vutoli, mbali yakumanja ya mtima siikula bwino.
- Tricuspid atresia: Valavu yomwe ili kumbali yakumanja ya mtima siinapangidwe bwino.
- Kutsekeka kwa magazi m'mapapo: Valavu yomwe imanyamula magazi kupita nawo m'mapapo imatsekeka.
- Magazi ochokera m'zipinda zonse ziwiri zakumtunda kwa mtima amalowa m'zipinda zakumanzere zokha.
- Matenda ena ambiri ovuta a mtima obadwa nawo.
Mayina awa angakupangitseni kukhala ndi mantha kwambiri. Koma awa ndi mayina okhawo omwe madokotala amagwiritsa ntchito pokudziwitsani. Chofunika ndichakuti pamavuto onsewa, valavu imodzi ya mtima imakhala ndi kupsinjika kwakukulu. Njira ya Fontan imayesetsa kuchepetsa kupsinjika kumeneko.
Kodi chimachitika ndi chiyani opaleshoni isanachitike?
Opaleshoni ya Fontan nthawi zambiri imachitidwa pa ana.Pakati pa zaka ziwiri ndi zisanu. Nthawi zina izi zimatha kuchedwa mpaka zaka pafupifupi 15. Koma opaleshoni iyi siingachitike kwa aliyense. Madokotala adzachita kaye mayeso kuti aone ngati mwana wanu ali woyenera opaleshoniyi.
Mwachitsanzo, selo limodzi logwira ntchito la mwana liyenera kukhala lolimba mokwanira kuti lizitha kupopa bwino. Komanso, mapapo ayenera kukhala athanzi mokwanira kuti alandire magazi omwe akubwera mwachindunji popanda thandizo la mtima.
Mayeso otsatirawa amachitidwa opaleshoni isanachitike:
- Transthoracic echocardiogram (TTE): Izi zili ngati kujambula mtima. Zimatha kuona bwino zipinda za mtima, ma valve, ndi kayendedwe ka magazi.
- Electrocardiogram (EKG): Iyi imayesa momwe mtima umagwirira ntchito, kutanthauza momwe mtima umagwirira ntchito.
- Kutsegula mtima: Kachipangizo kopyapyala kwambiri (catheter) kamadutsa m'mitsempha yamagazi yomwe ili m'mwendo kapena mkono kupita kumtima, ndipo kuthamanga ndi mpweya mkati mwa mtima zimayesedwa. Izi zingapereke chithunzi cholondola cha momwe mtima ulili opaleshoni isanachitike.
- Kuyang'ana kuchuluka kwa mpweya wopuma komanso mpweya wabwino m'thupi.
- Nthawi zina CT kapena MRI scan.
Mayeso onsewa amachitika kuti opaleshoniyi ikhale yotetezeka komanso yopambana momwe zingathere.
Kodi chimachitika ndi chiyani panthawi ya opaleshoni?
M’chipinda chochitira opaleshoni, mwanayo amapatsidwa mankhwala oletsa ululu kuti agone kuti asamve kupweteka kulikonse. Pa opaleshoni, makina ogwiritsira ntchito mtima ndi mapapo amagwiritsidwa ntchito kwakanthawi kuti agwire ntchito ya mtima ndi mapapo.
Kenako dokotalayo amalumikiza vena cava ya m'munsi, yomwe ndi mtsempha waukulu wamagazi womwe umanyamula magazi opanda mpweya kuchokera m'thupi la m'munsi, kupita ku mtsempha wa m'mapapo, womwe umanyamula magazi kupita ku mapapo, pogwiritsa ntchito njira yolumikizira magazi. Umu ndi momwe "njira yachidule" yomwe tidakambirana kale imapangidwira.
Nthawi zina, kukonza zinthu zina zazing'ono, monga kukonza valavu ya mtima, kungachitike nthawi yomweyo ndi opaleshoni iyi.
Opaleshoni yonse nthawi zambiri imatenga maola anayi kapena asanu . Panthawi imeneyo, gulu lachipatala lidzalankhula nanu nthawi zonse ndikukupatsani zosintha zokhudza matenda a mwana wanu.
Kodi ubwino ndi zoopsa za opaleshoniyi ndi ziti?
Monga opaleshoni iliyonse, opaleshoni ya Fontan ili ndi ubwino komanso zoopsa zina.
Ubwino waukulu ndi wakuti amachepetsa ntchito pamtima, zomwe zimapangitsa kuti ntchito yake ikhale yosavuta. Komanso, popeza magazi okhala ndi mpweya wambiri komanso opanda mpweya wambiri sasakanikirana bwino, mpweya womwe thupi limalandira umawonjezeka. Milomo ndi zikhadabo za mwana zimakhala zabuluu (cyanosis), ndipo amakhala ndi mphamvu zambiri zoti azichita zinthu mwachangu.
| Mavuto omwe angachitike pambuyo pa opaleshoni | |
|---|---|
| Mavuto a kanthawi kochepa | Mavuto a nthawi yayitali |
| Kuwonongeka kwa impso | Matenda a enteropathy omwe amataya mapuloteni (kuvuta kuyamwa mapuloteni) |
| Kulephera kwa mtima | Kuundana kwa magazi (embolism) |
| Kugunda kwa mtima kosakhazikika | Matenda a chiwindi (Fontan-associated chiwindi matenda - FALD) |
| Zotsatira pa ntchito ya chiwindi | Kutsekeka kwa njira zopumira ndi ntchofu yokhuthala (bronchitis ya pulasitiki) |
| Kuchulukana kwa madzi m'mapapo (pleural effusions) | |
Zinthu izi zingakhale zoopsa kuziona, koma kumbukirani kuti gulu lachipatala likudziwa zoopsa zonsezi. Iwo amakhala okonzeka nthawi zonse kuzipewa ndi kuzithetsa ngati zitachitika.
Kodi moyo uli bwanji pambuyo pa opaleshoni?
Pambuyo pa opaleshoni, mwanayo amalowetsedwa mu chipinda chosamalira odwala kwambiri (ICU) ndipo amamuyang'aniridwa mosamala. Pakatha masiku angapo, vutoli likayamba bwino, amasamutsidwira ku chipinda chachikulu. Mwana akhoza kukhala m'chipatala kwa masiku 7 mpaka 13 .
Musanapite kunyumba, madokotala ndi ogwira ntchito yosamalira ana adzakufotokozerani mwatsatanetsatane momwe mungasamalire mwana wanu, mankhwala oti mupereke, ndi zizindikiro zoti musamale nazo.
Kodi ndi liti pamene muyenera kulankhula ndi dokotala?
Mukabwerera kunyumba, muyenera kuyimbira dokotala nthawi yomweyo ngati muwona zizindikiro izi:
- Ngati magazi kapena madzi ena akutuluka kuchokera pa bala la opaleshoni.
- Ngati muli ndi malungo kapena zizindikiro zina za matenda (malungo, kutupa, kufiira).
- Ngati vuto la kupuma likuwonjezeka.
Mwana amene wachitidwa opaleshoni ya Fontan amafunika chisamaliro chamankhwala kwa moyo wake wonse. Nthawi zambiri amafunika kuonana ndi dokotala miyezi 6 mpaka 12 iliyonse . Afunikanso kuyezetsa nthawi zonse kuti awone momwe mtima ndi chiwindi chake zilili.
Chofunika kwambiri ndichakuti opaleshoni ya Fontan si "mankhwala." Ndi njira yothandizira mtima wa mwana kugwira ntchito bwino. Chifukwa chake, kutsatira kwa nthawi yayitali ndikofunikira.
Kodi munganene chiyani za moyo wa munthu?
Funso ili ndi lalikulu kwa makolo ambiri. Chiyembekezo cha moyo pambuyo pa opaleshoni ya Fontan chimadalira kuopsa kwa vuto la mtima lomwe mwana anali nalo.
Koma masiku ano, mankhwala apita patsogolo kwambiri. Anthu ambiri amakhala ndi moyo zaka 10 pambuyo pa opaleshoni. Anthu asanu ndi atatu mwa khumi amakhala ndi moyo zaka 30 kapena kuposerapo . Ndipotu, anthu ambiri omwe adachitidwa opaleshoni ya Fontan tsopano amakhala ndi moyo wa zaka 40 kapena kuposerapo.
Pakapita nthawi, mphamvu ya mtima wa anthu ena yopopa imatha kufooka, kapena chiwindi chingakhudzidwe. Izi zimatchedwa "Fontan yolephera." Pazochitika zotere , kuyika mtima wina kungafunike. Koma si aliyense amene amafunikira izi.
Mukazindikira kuti mwana wanu ali ndi vuto lalikulu la mtima ndipo akufuna kuchitidwa opaleshoni, mungamve zambiri. Mantha, nkhawa, komanso kusatsimikiza za tsogolo ndi zachibadwa. Koma chofunika kwambiri kudziwa ndichakuti simuli nokha .
Pambuyo pa opaleshoni iyi, mwana wanu amatha kusewera, kuphunzira, kukula, ndikusangalala ndi moyo monga mwana wina aliyense. Angatope msanga, kapena angafunike mayeso ena azachipatala. Koma, ndi upangiri woyenera wachipatala komanso chikondi chanu ndi chisamaliro chanu, akhoza kukhala ndi moyo wathunthu komanso wachimwemwe.
Uthenga Wopita Nawo Kunyumba
- Njira ya Fontan ndi opaleshoni yapadera ya mtima yomwe imachitidwa kwa ana omwe amabadwa ndi ventricle imodzi yokha yomwe imagwira ntchito.
- Izi zimapangitsa kuti magazi aziyenda bwino mumtima, zomwe zimathandiza kuti ntchito ya selo limodzi lokha lizigwira ntchito.
- Kawirikawiri iyi ndi gawo lomaliza la opaleshoni zingapo, ndipo imachitidwa pa mwana wazaka zapakati pa 2 ndi 5.
- Ngakhale opaleshoni ya Fontan siichiza matendawa kwathunthu, ingathandize kwambiri mwanayo kukhala ndi moyo wabwino komanso wokangalika.
- Pambuyo pa opaleshoni, kukaonana ndi dokotala nthawi zonse n'kofunika kwambiri pa moyo wanu wonse.
- Ndi kuyang'aniridwa bwino ndi chisamaliro chachipatala, ana ambiri omwe achitidwa opaleshoniyi amakhala ndi moyo wabwino komanso wodzaza ndi zonse.
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